scholarly journals Crohn’s disease: When to operate

2004 ◽  
Vol 51 (2) ◽  
pp. 61-68 ◽  
Author(s):  
A. Dziki ◽  
P. Galbfach
Keyword(s):  
Surgical Treatment ◽  
Pharmacological Treatment ◽  
Inflammatory Process ◽  
Surgical Intervention ◽  
Treatment Resistance ◽  
Steroid Dependence ◽  
Clear Cut ◽  
The Right ◽  
Resistance To Steroids ◽  
Indication For Surgical Treatment

Crohn?s disease is a chronic bowel condition, which can present as a number of different clinical and pathological presentations, depending on localization and activity of the inflammatory process. The aethiology of the disease has not been explained .In each case the treatment should be individually tailored depending on the type of the changes. The indications for surgical intervention are continuous bleedings, recurrent ileus, perforation of the intestine, abscesses, fistulas, failure of pharmacological treatment, resistance to steroids and steroid dependence. In case of the mild type of the disease with few symptoms pharmacological treatment is the right choice In case of the mild type of the disease with few symptoms pharmacological treatment is the right choice process. In malign form of Crohn?s disease lack of improvement after 7-10 days of intensive treatment is generally accepted indication for surgical treatment. Fulminant form of the disease is still a clear-cut indication for immediate surgical intervention. Decision on surgical intervention is more difficult and controversial when patient presents with series of subileus recurrences subsiding after conservative treatment. Patients with stenotic form of Crohn?s disease usually require multiple operations most of which are bowel resections. Patients with stenotic form of Crohn?s disease usually require multiple operations most of which are bowel resections therapy. External and internal asymptomatic fistulas should be treated conservatively. The timing of surgical treatment is essential in Crohn?s disease however the prevention from recurrences is also fundamental. It is well proved that preventive administration of 5-ASA (especially mesalazine) and metronidazol can reduce the risk of early recurrences after surgery.

A case of successful surgical treatment of patient with adrenal cyst using 3-d modeling

2020 ◽  
Vol 28 (4) ◽  
pp. 530-535
Author(s):  
Ivan Andreev ◽  
Alexander Kolsanov ◽  
Sergey Katorkin ◽  
Evgeniy Shestakov ◽  
Leonid Lichman
Keyword(s):  
Surgical Treatment ◽  
Surgical Resection ◽  
3D Modeling ◽  
Clinical Observation ◽  
Preoperative Planning ◽  
Clinical Presentation ◽  
Surgical Intervention ◽  
Adrenal Cyst ◽  
The Right ◽  
Medical University

Aim. Demonstration of potentials of preoperative planning and implementation of surgical resection in patients with adrenal cysts. A clinical observation of a successful surgical treatment of a rare pathology cyst of the right adrenal is presented. The choice of surgical treatment tactics is determined by the size of tumor and clinical presentation of the disease. The surgical treatment was accomplished laparoscopically which permitted to reduce the time of recovery and rehabilitation of the patient. In this clinical observation, the benefit of using 3D-modeling of the surgical area was shown for visualization of topographic and anatomic peculiarities and facilitation of the intraoperative navigation with the help of Avtoplan program developed by Samara State Medical University. Conclusion. Preoperative 3D-modeling permits to prepare to surgical intervention taking into account individual anatomic peculiarities of a patient, and to determine the optimal volume of the operation.

Tactics and treatment results for uveal complications of laser coagulation with retinopathy of prematurity

2021 ◽  
pp. 375-379
Author(s):  
Y.D. Kuznetsova ◽  
◽  
I.B. Astasheva ◽  
I.E. Hatsenko ◽  
A.N. Zvereva ◽  
...  
Keyword(s):  
Birth Weight ◽  
Surgical Treatment ◽  
Postoperative Period ◽  
Retinopathy Of Prematurity ◽  
Inflammatory Process ◽  
Surgical Intervention ◽  
Cataract Extraction ◽  
Laser Coagulation ◽  
Complete Relief ◽  
Iol Implantation

A pronounced inflammatory process from the anterior and posterior parts of the eye may occur, as a complications after laser coagulation in retinopathy of prematurity (ROP), in which there is a need for surgical treatment. Purpose. To determine the optimal tactics for the treatment of uveal complications of laser coagulation in ROP. Material and methods. For 2014-2020 we examined and performed surgical intervention in 21 children with uveal complications after laser coagulation (27 eyes), Most of the children were deeply premature (born at 24-26 weeks of gestation) with a birth weight of 500 g to 900 g with concomitant pathology from the central nervous system. Сomplicated cataracts developed for all children. All children underwent surgical treatment: reconstruction of the anterior chamber, microinvasive cataract extraction, vitrectomy (if necessary, schvartectomy). A single surgical intervention was performed on 24 eyes. In 3 eyes with a post-aggressive form of ROP and a history of sepsis, reoperative treatment was required. All children had no primary IOL implantation. IOL implantation was performed in one childe at an older age. Results. As a result of the treatment, in 89% of cases (24 eyes), there was a complete relief of the inflammatory process and restoration of the transparency of the media after a single surgical intervention. In childe who underwent secondary IOL implantation in the long term, there was a complicated course of early postoperative period and repeated reconstructive surgery required. Conclusions. Uveal complications after laser coagulation of the retina for ROP are observed mainly in children born in early gestation (24-26 weeks) with low birth weight (less than 1000 g). When carrying out the surgical treatment of uveal complications - cataract extraction, which has developed as a result of laser coagulation for ROP, vitrectomy is mandatory, and, if necessary, schwartectomy. When deciding on the secondary implantation of IOLs, it is necessary to take into account the high probability of an unfavorable course of the postoperative period in children with previous uveitis after laser treatment for retinopathy and prematurity. Key words: retinopathy of prematurity, uveal complications, cataract.

Features of the ovarian reserve in women with infertility after organ-preserving operations on the pelvic organs

2017 ◽  
pp. 46-49
Author(s):  
A.E. Dubchak ◽  
◽  
O.D. Dubenko ◽  
O.V. Milevsky ◽  
N.M. Obeid ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Ovarian Reserve ◽  
Inflammatory Process ◽  
Surgical Intervention ◽  
Reproductive Potential ◽  
Uterine Fibroids ◽  
Chronic Inflammatory Process ◽  
Antral Follicles ◽  
Pelvic Organs ◽  
Internal Genitalia

Ovarian reserve (OR) – an important part of the reproductive potential of women, is the ability of the ovaries to provide growth of full-blown follicles containing healthy, fertile eggs. The objective: to evaluate the characteristics of the OR in women with infertility after organ-saving operations on the pelvic organs Patients and methods. 128 women with infertility and hyperplastic diseases of the uterus and appendages (HDUA) were examined. Of these, 54.5% had a chronic inflammatory process of the internal genitalia (CIPIG). 42 patients with HDUA with CIPIG were treated conservatively, 28 patients with HDUA under the condition of CIPIG performing organ-preserving treatment, 27 women with GDUA without CIPIG performed conservative treatment, 31 patients with HDUA without CIPIG carrying out organ-preserving treatment. The volume of ovaries and the number of antral follicles (AF), the amount of anti-Muller hormone (AMG) were studied. Results. In the surveyed women, after surgical treatment, a decrease in the volume of the ovaries and the amount of аntral follicles (AF) was revealed, mainly due to ovarian resection. There was also a decrease in AMG. Moreover, the volume of operated ovaries in the group of patients who underwent cystectomy was significantly lower than in patients after resection or bipolar electrodeletion of the cyst capsule. Such changes in the ovarian reserve in the postoperative period can be explained by the volume of surgical intervention not only on the uterus, but also on the ovaries. Conclusion. The condition of the ovarian reserve in women with infertility against the background of uterine fibroids largely depends on the concomitant volume of surgical intervention. Cystectomy or ovarian resection, even in a sparing volume, is accompanied by a risk of a decrease in primordial and antral follicles. Key words: ovarian reserve, infertility, AMH, operations on pelvic organs, ultrasound.

scholarly journals Successful Surgical Treatment of a Giant Left Coronary Artery Aneurysm with Fistula

2021 ◽  
Vol 24 (5) ◽  
pp. E868-E869
Author(s):  
Huadong Li ◽  
Hong Yu ◽  
Yu Song ◽  
Lu Tong ◽  
Meng Zhao ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Surgical Treatment ◽  
Rare Case ◽  
Left Coronary Artery ◽  
Coronary Artery Aneurysm ◽  
Surgical Intervention ◽  
Artery Aneurysm ◽  
Fistula Formation ◽  
The Right ◽  
Low Prevalence

Coronary artery aneurysm (CAA) is an aortic catastrophe with low prevalence. Giant CAA is even more uncommon, requiring surgical intervention. Giant CAA usually originates from the proximal segments of the right coronary and the anterior descending arteries. Here we report a rare case of giant left CAA with fistula formation treated with successful surgery.

Successful treatment of conversion chemotherapy for initially unresectable synchronous colorectal liver metastasis

2020 ◽  
Author(s):  
Lungwani Muungo
Keyword(s):  
Liver Metastasis ◽  
Colorectal Liver Metastasis ◽  
Surgical Intervention ◽  
Liver Volume ◽  
Sigmoid Colon Cancer ◽  
Remnant Liver ◽  
Future Remnant Liver ◽  
The Right ◽  
Synchronous Colorectal Liver Metastasis ◽  
Right Hepatic Vein

A 72-year-old woman with a sigmoid colon cancer anda synchronous colorectal liver metastasis (CRLM), whichinvolved the right hepatic vein (RHV) and the inferiorvena cava (IVC), was referred to our hospital. Themetastatic lesion was diagnosed as initially unresectablebecause of its invasion into the confluence of theRHV and IVC. After she had undergone laparoscopicsigmoidectomy for the original tumor, she consequentlyhad 3 courses of modified 5-fluorouracil, leucovorin,and oxaliplatin (mFOLFOX6) plus cetuximab. Computedtomography revealed a partial response, and theconfluence of the RHV and IVC got free from cancerinvasion. After 3 additional courses of mFOLFOX6 pluscetuximab, preoperative percutaneous transhepaticportal vein embolization (PTPE) was performed tosecure the future remnant liver volume. Finally, a righthemihepatectomy was performed. The postoperativecourse was uneventful. The patient was dischargedfrom the hospital on postoperative day 13. She hadneither local recurrence nor distant metastasis 18 moafter the last surgical intervention. This multidisciplinarystrategy, consisting of conversion chemotherapy usingFOLFOX plus cetuximab and PTPE, could contributein facilitating curative hepatic resection for initiallyunresectable CRLM.Key words: Initially unresectable; Colorectal liver metastasis;Conversion chemotherapy; Cetuximab; Percutaneoustranshepatic portal vein embolization

scholarly journals Surgical treatment for common hepatic aneurysm. Original one-step technique

Open Medicine ◽  
2020 ◽  
Vol 15 (1) ◽  
pp. 898-904
Author(s):  
Bruno Amato ◽  
Renato Patrone ◽  
Gennaro Quarto ◽  
Rita Compagna ◽  
Roberto Cirocchi ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Hepatic Artery ◽  
Distal Part ◽  
Intraoperative Ultrasound ◽  
Section Area ◽  
One Step ◽  
A New Technique ◽  
Open Surgical Treatment ◽  
The Right ◽  
Vascular Stapler

AbstractIntroductionHepatic artery aneurysms are rare, and their treatment represents a challenge for the surgeons.Materials and methodsA new technique is presented for common hepatic artery (CHA) aneurysm: it requires minimal vascular surgical dissection and only one linear vascular stapler is applied at the bottom of aneurysm. Aneurysm exclusion is easily obtained, which allowed retrograde thrombosis. Liver blood supply is ensured to the right and left hepatic artery, through the gastroduodenal artery, and can be previously monitored, with temporary clamping of the section area, by visual control, enzyme evaluation and intraoperative ultrasound examination. We reported an open surgical treatment, with simultaneous removal of hepatic and adrenal metastases, secondary to colon cancer.ResultsThe duration of vascular surgery was 30 min and did not involve complications. Postoperative controls confirmed the efficacy of the procedure.DiscussionThis original technique can be added to the various open and endovascular techniques so far described for the treatment of a CHA aneurysm. It is advisable as open surgery, mostly in case of associated pathologies.ConclusionsThe authors believe that this “one shot” technique by vascular staple of the distal part of CHA is minimally invasive and effective to obtain the exclusion of the aneurysm.

The Use of Eye Tracking to Discern the Threshold at Which Metopic Orbitofrontal Deformity Attracts Attention

2020 ◽  
Vol 57 (12) ◽  
pp. 1392-1401
Author(s):  
Mark P. Pressler ◽  
Emily L. Geisler ◽  
Rami R. Hallac ◽  
James R. Seaward ◽  
Alex A. Kane
Keyword(s):  
Surgical Treatment ◽  
Graduate Students ◽  
Eye Tracking ◽  
Dwell Time ◽  
Surgical Intervention ◽  
Three Dimensional ◽  
Average Dwell Time ◽  
Eye Tracker ◽  
Gaze Patterns ◽  
Areas Of Interest

Introduction and Objectives: Surgical treatment for trigonocephaly aims to eliminate a stigmatizing deformity, yet the severity that captures unwanted attention is unknown. Surgeons intervene at different points of severity, eliciting controversy. This study used eye tracking to investigate when deformity is perceived. Material and Methods: Three-dimensional photogrammetric images of a normal child and a child with trigonocephaly were mathematically deformed, in 10% increments, to create a spectrum of 11 images. These images were shown to participants using an eye tracker. Participants’ gaze patterns were analyzed, and participants were asked if each image looked “normal” or “abnormal.” Results: Sixty-six graduate students were recruited. Average dwell time toward pathologic areas of interest (AOIs) increased proportionally, from 0.77 ± 0.33 seconds at 0% deformity to 1.08 ± 0.75 seconds at 100% deformity ( P < .0001). A majority of participants did not agree an image looked “abnormal” until 90% deformity from any angle. Conclusion: Eye tracking can be used as a proxy for attention threshold toward orbitofrontal deformity. The amount of attention toward orbitofrontal AOIs increased proportionally with severity. Participants did not generally agree there was “abnormality” until deformity was severe. This study supports the assertion that surgical intervention may be best reserved for more severe deformity.

Successful surgical treatment of a giant coronary aneurysm communicating with the right atrium

2007 ◽  
Vol 8 (12) ◽  
pp. 1061-1064 ◽  
Author(s):  
Andrea Rognoni ◽  
Valeria Ferrero ◽  
Giovanni Teodori ◽  
Flavio Ribichini
Keyword(s):  
Surgical Treatment ◽  
Right Atrium ◽  
Coronary Aneurysm ◽  
Giant Coronary Aneurysm ◽  
The Right

scholarly journals MEAN 6 YEAR CLINICAL OUTCOMES, SURVIVORSHIP, AND RETURN TO SPORTS AFTER ARTHROSCOPIC CAPSULAR REPAIR WITH SUTURE ANCHORS FOR ADOLESCENT MULTIDIRECTIONAL SHOULDER INSTABILITY

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0002
Author(s):  
Brendon C. Mitchell ◽  
Matthew Y. Siow ◽  
Alyssa Carrol ◽  
Andrew T. Pennock ◽  
Eric W. Edmonds
Keyword(s):  
Risk Factors ◽  
Surgical Treatment ◽  
Shoulder Instability ◽  
Surgical Intervention ◽  
Operation Time ◽  
Demographic Variables ◽  
Return To Sports ◽  
Suture Anchors ◽  
Surgical Failure

Background: Multidirectional shoulder instability (MDI) refractory to rehabilitation can be treated with arthroscopic capsulolabral reconstruction with suture anchors. No studies have reported on outcomes or examined the risk factors that may contribute to poor outcomes in adolescent athletes. Hypothesis/Purpose: To identify risk factors for surgical failure by comparing anatomic, clinical, and demographic variables in adolescents who underwent surgical intervention for MDI. Methods: All patients undergoing arthroscopic shoulder surgery at one institution between January 2009 and April 2017 were reviewed. Patients >20 years old at presentation were excluded. Multidirectional instability was defined by positive drive-through sign on arthroscopy plus positive sulcus sign and/or multidirectional laxity on anterior and posterior drawer testing while under anesthesia. Two-year minimum follow-up was required, but those whose treatment failed earlier were included for reporting purposes. Demographics and intraoperative findings were recorded, as were Single Assessment Numeric Evaluation (SANE) scoring, Pediatric and Adolescent Shoulder Survey (PASS), and the short version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) results. Results: Eighty adolescents (88 shoulders) were identified for having undergone surgical treatment of MDI. Of these 80 patients, 42 (50 shoulders; 31 female, 19 male) were available at a minimum of 2-year follow-up. Mean follow-up was 6.3 years (range, 2.8-10.2 years). Thirteen (26.0%) shoulders experienced surgical failure defined by recurrence of subluxation and instability, all of which underwent re-operation. Time to re-operation occurred at a mean of 1.9 years (range, 0.8-3.2). Our cohort had an overall survivorship of 96% at 1 year after surgery and 76% at 3 years. None of the anatomic, clinical, or demographic variables tested, or the presence of generalized ligamentous laxity, were correlated with subjective outcomes or re-operation. Number of anchors used was not different between those that failed and those that did not fail. Patients reported a mean SANE score of 83.3, PASS score of 85.0, and QuickDASH score of 6.8. Return to prior level of sport (RTS) occurred in 56% of patients. Conclusion: Multidirectional shoulder instability is a complex disorder that can be challenging to treat. Adolescent MDI that is refractory to non-surgical management appears to have long-term outcomes after surgical intervention that are comparable to adolescent patients with unidirectional instability. In patients who do experience failure of capsulorraphy, we show that failure will most likely occur within 3 years of the index surgical treatment. [Table: see text][Figure: see text]

Intracardiac Self Insertion of a Darning Needle in a Psychiatric Patient

2021 ◽  
Vol 4 (5) ◽  
pp. 01-13
Author(s):  
Avra Laarakker
Keyword(s):  
Left Ventricle ◽  
Psychiatric Patient ◽  
Surgical Intervention ◽  
Case Reports ◽  
Interventricular Septum ◽  
Intravenous Drug User ◽  
Standard Of Care ◽  
Pubmed Search ◽  
Needle Entry ◽  
The Right

Objective: We report a case of self inserted needle into the left ventricle of the heart and a description of our surgical intervention in a psychiatric patient without decision-making capacity. We discuss issues regarding obtaining consent in this patient with a sub-acute presentation, report our operative approach, and summarize a treatment approach based on a review of current literature. Methods: A PubMed search using terms “needle, “heart”, “insertion”, “intracardiac foreign object”, yielded 69 relevant papers. 67 of these were case reports yielding 72 individual cases. Age, gender, cause of the needle entry (Accidental Plus (A+), Intravenous Drug User [IVDU], Self-inflicted (SI)), type of needle, location in heart, neuropsychiatric history, treatment, and outcome were documented. Results: Within the SI category, there were a total of 28 cases, 89.3% had a neuropsychiatric history whereas only there were only 2 such patients in both the IVDU and A+ group. The location of the needle in the heart in all 72 cases was as follows: right ventricle 40.3%, other 20.8%, left ventricle 19.4 %, ventricle and interventricular septum 16.7% and the right and left atrium were each 1.4 %. In all three groups (n=72), 77.8% of patients underwent surgery, with 92.9% having a stable outcome. Conclusion: Our case and review demonstrates that management of such cases, particularly when active mental health issues are present, requires a case-by-case evaluation and treatment as a specific standard of care has not been established. Surgical intervention appears to be the preferred management regardless of presentation with good outcomes. Running Title: Intracardiac Self Insertion of a Darning Needle in a Psychiatric Patient

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